Abstract
Mycobacterium abscessus is an environmental non-tuberculous mycobacteria causing severe lung infections in cystic fibrosis patients. Its intrinsic resistance to antibiotics renders treatments extremely challenging. This pathogen has developed a wide panel of strategies to resist to antibiotics, including efflux pumps and target-modifying enzymes. Standard antibiotherapy combines an aminoglycoside (amikacin (AMK)), -lactams (imipenem (IPM)) and macrolides (clarithromycin (CLR) or azithromycin (AZM)). My thesis was focusing on the regulation of antibiotic resistance mechanisms involving efflux pumps from the MmpL family as well as an enzyme modifying the macrolide target. Selection of resistant mutants against thiacetazone derivatives (TACd) and clofazimine (CFZ) unraveled mutations in the TetR regulators MAB_4384 and MAB_2299c, respectively. The CFZ-mutants, also co-resistant to bedaquiline (BDQ), overexpress two distinct MmpS/MmpL, MAB_135c/1134c and MAB_2300/2301 while the TACd mutants overproduce the MAB_4383c/4382c efflux pump. Biochemical, genetic and structural approaches confirmed their involvement in drug resistance mechanisms. MAB_2299c could therefore represent a potential resistance marker to monitor in strains isolated from patients under CFZ/BDQ therapy. The methyltransferase Erm(41) modifies the adenosine 2058 of the ribosomal 23S rRNA, protecting the ribosome from the macrolides. WhiB7 may represent a major actor in inducible resistance, observed in 40% of clinical cases, often leading to treatment failure. We confirmed the role of WhiB7 in this process and showed that inducible resistance occurred also in vivo in the zebrafish model. Our data suggest that AZM is a stronger and faster resistance inducer than CLR in vitro and that both drugs show antagonism with AMK, thus reducing drugs’ efficacy. This work enriched our knowledge regarding both MmpL-mediated and macrolides inducible resistance mechanism against M. abscessus. It also provides new efficient tools to investigate the function of proteins through a novel unmarked gene deletion approach and to rapidly assay new antibiotics to counteract inducible macrolide resistance.